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DIABETES MELLITUS - Coggle Diagram

- - - - Diet (3) - least important
      - Insulin (1) - most important
      - Exercise (2)
  - - - Diet (1) - most important
      - Oral hypoglycemics (3)
      - Activity (2)
  - - - Lower blood sugar
    - - Insulin type: R - Regular
        
        R: Regular, Rapid, Run (IV)
        
        Clear
        
        OPD
        
        Onset: 1 hour
        
        Peak: 2 hours
        
        Duration: 4 hours
        
        Short Acting
      - Insulin type: N - NPH
        
        N: NPH, Not in the bag, Not so fast, Not Clear
        
        Cloudy
        
        "Never put a cloudy in an IV bag"
        
        OPD
        
        Onset: 6 hours
        
        P: 8-10 hours
        
        Duration: 12 hours
        
        Intermediate Acting
      - HUMALOG (Insulin Lispro)
        
        Fastest Acting
        
        WITH meals not AC
        
        ODP
        
        Onset: 15 minutes
        
        Peak: 30 minutes
        
        Duration: 3 hours
      - Lantus (Glargine)
        
        Long acting
        
        ODP
        
        Onset: Slow Absorption
        
        Peak: No peak, therefore NO RISK OF HYPOGLYCEMIA
        
        Duration: 12-24 hours
  - - - More exercise
        
        decrease insulin
      - Less exercise
        
        increase insulin
  - - - Take Insulin (even if not eating
      - Take sips of H20 to prevent Dehydration
      - Stay as active as possible
- - - - Not enough food
      - Too much exercise
      - Too much insulin - Primary cause (OVERMEDICATED!!!)
    - - Permanent BRAIN damage
    - - Administer rapidly metabolizable Carbohydrates (sugar)
        
        Examples
        
        Any juice
        
        Low calorie, sugar free pop
        
        Chewed up candy
        
        Honey
        
        Icing
        
        Jam
        
        Jelly
      - Ideal combination
        
        Food with sugar and protein (and maybe startch)
        
        Examples
        
        Apple juice and crackers
        
        Apple juice and a slice of turky
        
        skimmed milk (sugar + protein)
      - If unconscious
        
        Nothing per orem!
        
        Glucagon IM (can be used if outside of the hospital setting)
        
        Dextrose IV (hospital setting)
    - - "DRUNK IN SHOCK"
        
        Cerebral impairment and vasomotor collapse
        
        Cause
        
        Blood vessel wall muscles don't have enough E to maintain tone
        
        S/Sx
        
        Slurred speech
        
        Staggered gait
        
        Abnormal reaction time
        
        Uncontrolled emotions
        
        Lowered BP
        
        Increased Pulse
        
        Skin pale, cold, clammy
        
        Inattentive to social boundaries
        
        Mottled, patchy extremities
  - - - Too much food
      - Not enough insulin
      - Not enough exercise
      - #1 cause is acute viral upper respiratory infection within the last week or two
    - - Dehydration
        
        appear dry, hot, flush, HA
        
        Weak and thready pulse
        
        Increase in temp
      - Ketones (in urine and blood)
        
        Increase in K+
        
        Kussmaul respirations
      - Acidotic
        
        Acetone (fruity) breath
        
        Anorexia with nausea
    - - IV with Regular Insulin @ 200/hr at high/fast rate
  - - - Hyperosmolar, Hyperglycemic, NON-KETOTIC, coma
    - - Are like S/sx of dehydration
        
        Including: increased temp
    - - Rehydrate
      - Glucose will usually turn to normal on its own
  - - - Renal failure
        
        Wounds don't heal well
    - - loss control of bladder/incontinence
        
        don't feel anything when injured
  - - - HA1C for dx
        
        6.5 (DM/Pre DM)
      - Monitoring treatment
        
        7.0 (OUT OF CONTROL)
- - - - Polyuria
        
        Polydipsia
        leading to dehydration
        d/t a low ADH
    - - Only in fluids
    - - High U.O
- - - - Insulin dependent
      - Juvenile Onset (wont be used after april 1)
      - Ketosis prone (tend to make ketones)